ASSOCIATION OF MEDICAL LABORATORY SCIENTISTS OF NIGERIA

 

Observations and recommendations of Association of Medical Laboratory Scientists of Nigeria (AMLSN) on the Report of The Presidential Committee of Experts on inter-Professional Relationships in the Public Health Sector (PCEIRPHS)-ALHAJI YAYALE AHMED'S Committee of Experts

 

The Association of Medical Laboratory Scientist of Nigeria (AMLSN) IS dismayed and shocked by the recommendations of the above Committee submitted on the 19th December, 2014, to His Excellency Dr. Goodluck Ebele Jonathan (GCFR). It is obvious, that the document is no longer a secret document as so many opinions have since been expressed on the report by different stakeholders. AMLSN hereby wishes to state as follows: 

 

1. Though. we have observed some acceptable recommendations by the committee in order to move the-health sector forward, we are pained to also note that there are some obnoxious recommendations by the PCEIRPHS that must be expunged from the report. Rather that throw away the baby with the bath water, we demand that the attention of the white paper committee on the PCEIHRPHS be drawn to areas of contradictions in the report. 

 

2. Some sections of the PCEIRPHS recommendations are against the spirit of the civil service and its rules, the report under rates professions and professionalism, it contradicts the concept of professional service, it ignores some existing government policies, it also attempts to misinform government and exhibited a commitment to satisfying the interest of the Nigeria Medical Association. 

 

(A) On restructuring of the Federal Ministry of Health to favour the Growth and Development of health Professionals other than Doctors/Dentists (2.3.11).

The recommendation of the committee exhibited some of the deficiencies enumerated in 2 above. 

 

(I) There is no reason why the recommended departments of Port Health Services and Family Health should not remain in Public Health Department. Family Health and Port Health Services are integral components of Public Health. 

 

(ii) The creation of a Department of Medical Laboratory Services which has long been advocated for in the FMOH and which has been enshrined in the Nigeria Medical Laboratory Service Policy adopted by the National Council on Health in 2007 was ignored in the recommendation of the committee. Why the committee decided to ignore this fact and proceeded to recommend other unnecessary ones is hard to justify. The white paper committee should please address this injustice to Medical Laboratory Scientists. While there are departments created for and headed by the Nurses, Pharmacists, and Physiotherapists in the Yayale Ahmed's committee of experts, Medical Laboratory Services department was ignored by the committee. Rather, it was put in a division so that medical laboratory scientists could be perpetually headed by another and different professional group. 

 

(B) Under its recommendation on the parastatals of the Federal Ministry of Health (2.4.4), 

(I) We observed that there is deliberate attempt to mislead government into believing that Pathology, Ophthalmology, O&G and Radiology are separate professions outside medicine and surgery whereas these are not professions but sub-specialties under medicine and surgery. 

 

(ii) For the avoidance of doubt, the regulated professions in medical and health includes medicine/surgery, Pharmacy, Nursing. Medical Laboratory Science, Physiotherapy. Radiography, Optometry, etc. Each these are a coded professions that must maintain their regulatory agencies and professional autonomy. 

 

(C) On the recommendation of Overlap and Deputation of Functions of the Regulatory Agencies (2.7.13) 

(i) The recommendation contradicts the National Health Act 2014 and regulatory laws of various health professionals, 

(ii) The committee is attempting to bring through the back door, things rejected from the early versions of the National Health Bill.  

(iii) There is a deliberate attempt at creating confusion by the inclusion of Science Laboratory Technology Regulatory Board that is a parastatal under the supervision. of the Federal Ministry of Science and Technology, 

(iv) The committee did not elaborate on such area. of overlap of the functions of Medical Laboratory Scientists and that of Science laboratory Technologists. 

 

We strongly believe that the mandates of Science Laboratory Technology (SLT)are quite distinct and separate from that of Medical Laboratory Science (MLS). 

 

(D) On Lack of access by regulatory agencies to the premises of Healthcare Providers for inspection (2.7.24). 

(I) We observed that the committee erroneously believed that the crisis in health sector was as a result of the activities of regulatory agencies in the health sector. Whereas, all health regulatory agencies have their enabling laws that clearly define their exclusive functions and mandates. There is no reason at all why this should cause crisis if all regulatory agencies stick to their respective mandates as contained in their respective enabling laws. 

(ii) However, we want to draw the attention of government to the existing government white paper on Orosanye committee's recommendation. 

 

(E) Composition of boards of tertiary institutions (3.2.16) 

(I) The World Health Organization(WHO) has said that the Laboratory is the cornerstone of modem evident based healthcare practice. The WHO harped on the need to strengthen medical laboratory practice globally and at all levels of healthcare. 

(ii) Medical laboratory science alone produces up to 70% of the empirical data that constitutes the evidence in modern healthcare practice. These results are generated by Medical Laboratory Scientists and sometimes by medical laboratory technicians and assistant. working under the supervision of Medical Laboratory scientists. The National Medical Laboratory Services Policy because of the significant functions, has recommended the creation of a separate department of medical laboratory services in the Federal Ministry of Health as a distinct department. 

(iii) In healthcare practice, the laboratory produces invaluable data for purposes of making diagnosis, determining suitability of therapeutic agents, best course of management, monitoring treatment and satisfaction of healthcare outcome. 

(iv) No healthcare institution should therefore fail to have a medical laboratory scientist on its workforce. There is therefore no reason why a medical laboratory scientist is not on each board (If tertiary health institutions. 

 

 

(F) Inequity in institutional leadership/headship (3.2.5). 

(I) With reference to recommendation 25 (a). whereas there is a recommendation by Justice Bello Gusau's Committee, that the position of the CMD should be democratized and made open to all eligible healthcare professionals. 

(ii) Aside from above, there is a pending case suite no FHC/AWK/CS/38/2013 pending at Federal high Court, Awka on the definition of who is medically qualified. Therefore, it is subjoined for the committee to recommend that the position is only for medical doctors. 

 

(G) Merging of Disparate Regulatory Agencies resulting (3.3.7) 

(I) All regulatory agencies in health are distinct and separate. their exclusive mandates are not the same. For example, Science Laboratory Technology is regulated by Institute of Science Laboratory Technology (NISLT), an agency under Ministry of Science and Technology. It is saddled with specific mandates of ensuring standards in science laboratories of secondary schools, polytechnics, universities, research institutes and other higher institutions. Unlike, the Medical Laboratory Science Council of Nigeria (MLSCN) which is under the Federal Ministry of Health which regulates, inspects, register and accredits medical laboratories. It also registers and license Medical Laboratory Scientists, registers Medical Laboratory Technicians and Medical Laboratory Assistants and also determines standards and skill required for persons seeking to become Medical Laboratory Scientists, Medical Laboratory Technicians and Medical Laboratory Assistants who are indispensable human resource for health. It is for this reason that MLSCN and NISLT are separate and distinct regulatory bodies. 

 

It will be recalled that on 5th of September 2013, President Goodluck Ebele Jonathan (GCFR) in realization of one of the important mandates of MLSCN, officially commissioned the federal government funded In Vitro Diagnostics (IVDs) laboratory located in Yaba Lagos. The objective is to empower MLSCN in her courageous efforts at eradicating sales, marketing, and distribution of substandard and fake medical laboratory diagnostic reagent and equipment in Nigerian health institutions both public and private. No doubt, because of porous borders of Nigeria, so many fake and sub-standard medical laboratory diagnostic reagent and equipment are marketed for use in medical laboratories. This has been identified as one of the most important causes of unreliable diagnostic laboratory test results in Nigeria in spite of the highly trained and skilled Medical Laboratory Scientists. 

 

As part of the strategies to ensure standard and quality of medical laboratory services globally, the World Health Organization (WHO), in December 2014 accredited and registered MLSCN as a member of International Laboratory Accreditation Committee (ILAC). The implication of this is that MLSCN by virtue of its regulatory functions as empowered in the enabling law, is now internationally recognized to carry our medical laboratory accreditation on behalf of the global technical committee of WHO in charge of medical laboratory accreditations. This will prevent loss of foreign reserves by Nigeria as witnessed when South Africa through South African National Accreditation Services (SANAS) was doing accreditation for Nigerian medical laboratories. 

 

(ii) A closer look at recommendations 11 (a), (b), (c) and (d) of the Alhaji Yayale Ahmed Committee's report showed that some of the recommendations are extremely ambiguous and appeared un-implement able. For instance, recommendations 17(c) and (d) are contradictory to (b). The art of regulation, evaluation, accreditations of diverse and distinct health professions will be too enormous and overwhelming to be handled by one or two regulatory agencies. Merging any of MLSCN, NAFDAC, MDCN, SON, PCN etc into one agency will further rubbish the quality of health systems and create further cruses among the different and distinct health professionals. the crisis would even be worse than what we could ever imagined.

 

(iii) Beside, some of the recommendations are already better captured in the National Health Act, 2014.

 

(iv) Strategies for merging of the Regulatory Agencies performing same of similar functions (not those performing disparate functions) had earlier been recommended in the white paper of the Orosanye Committees and has already taken is care of this. The recommendation of the Yayale Committee should therefore be disregarded. 

 

(H) Non/Selective/Pamal Implementation of the Scheme of Service (5.2.8) 

(I) This recommendation is practically impossible because no profession can have two separate Schemes of Service for the same professional service Physicians, Pharmacists. Medical Laboratory Scientists etc already have their schemes of service. We therefore, do not know which other scheme of services Yayale Ahmed committee was recommending for these professionals in her report. 

 

(ii) On proliferation of cadres. this is not unexpected as the medical field evolves, and as science is dynamic. other relevant cadres will likely emerge. 

 

(iii) In order to ensure a dedicated and motivated workforce, everyone should be granted the opportunity of rising to the peak of his/her profession and to head it. It is inconceivable that one autonomous profession should attempt to supervise and head the work of another autonomous profession. . 

 

(I) Unfettered Access to Radiographers and other Medical imaging professionals (7.2.8). 

(i) Professionals perform duties in their own rights because they arc licensed to perform such duties. Those duties specified for them in their scheme of service and job description. therefore, should not be hindered in any way. Medical Laboratory Scientists must perform their responsibilities in the interest of the patients they have sworn to serve. 

 

(ii) Pathologists are physicians and they are only licensed to practice medicine and surgery as a profession. They are consultants to their colleagues who are physicians. They arc not consultants to Medical Laboratory Scientists. They therefore cannot head or supervise laboratories where Medical Laboratory Scientists practice their profession. Therefore, recommendations 49 (b) and (e) are not acceptable and will further fuel crisis and should be expunged based on the following reasons: 

 

Ethical: Ethically, the requesting physician or the patients him/herself'(in patients' authorized testing) is the clients of the laboratory. If the physician requires the interpretation of a pathologist he can request the attention of any pathologist. An autonomous professional group cannot be sub-summed under another professional group. In the building Sector, Surveyors, Architects, Engineers, Builders etc are different professionals; yet none is made to be under the other. In fact, overlapping occurs in their functions too. For example the product of Surveyors is the raw material for Architects while the product of 

the latter is the raw material for Engineers. Builders etc. inspire of the overlaps, their respective professional autonomy is respected and recognized. None supervises or heads the other. 

 

Administrative: The scheme of service for physicians (pathologists) does not permit them to supervise Medical Laboratory Scientists or even work independently in the medical laboratory to generate results for clinical use. As clinicians/physicians. a they are to use results from Medical Laboratory Scientists to run specialists clinics and not to run medical laboratories. The scheme of service for Medical Laboratory Scientists allows them to work independently of the pathologists. The scheme of Service and the law therefore, allow Medical Laboratory Scientists to run, administer and head medical laboratory services. 

This had been supported and upheld by the declarative judgment of the National Industrial Court NICN/ABJ/128/2012) delivered on the 23th October, 2013. 

 

Legal: ACT cap M25 LFN, 2004, criminalizes the practice and the persons not so licensed as Medical Laboratory Scientists or registered as Medical Laboratory Technicians or Medical Laboratory Assistants who engage in the laboratory testing for the possess of treating patients. Any other person claiming to perform this function independently except for the purposes of research or students' practices is criminally impersonating. 

 

(J) Discrimination in the implementation of same provisions of the enabling laws of some professional bodies (9.2.8). 

We are surprised that the committee opined that conflict exist between the regulatory. laws of Medical Laboratory  Science Council of Nigeria Act and Medical and Dental Practitioners Act or any other regulatory law whereas no conflict whatsoever exists. This has also been expressly stated in the court judgment NICN/ABJ/128120 12. 

 

(K) Immediate withdrawal of CBN Circular Authorizing Medical Lab. Science Council of Nigerian (MLSCN) to approve license for the importation of IVDS (9.7,8).

(I) In the opinion of the committee, there was conflict between the MLSCN and NAFDAC laws. We wish to categorically re-affirm that no such conflict or any contentious provisions exists between the two laws, one is specific and the other is generalized. Since the laws are in harmony, there is no need whatsoever, for any review in the name of resolving a non-existing conflict between them. 

 

(L) Establishment of the office of surgeon General of the Federation (2.5.11). 

(i) The establishment of the office of the Surgeon General of the Federation or Chief Medical Adviser to the President has already been rejected in the school of public opinion. The recommendation is an attempt to bring Surgeon General in a different name through the 'back door. 

(ii) This issue was also debated and thrown out in the National Assembly when considering the National Health Bill and at the National Conference. 

Creating the position of Chief Medical Adviser will lead to increase in the cost of governance, create bureaucratic bottle necks and duplication of activities and functions that are already being carried out by the relevant departments in the Ministry of Health, and under the supervision of Honourable Minister of Health and Minister of State for Health. 

 

(M) Inequity in Institutional leadership/Headship (3.2.32) 

(i) Health service administrators have been driven almost to extinction. This is one very important health workforce that has been frustrated out of job. 

 

We therefore, recommend that Health administrators should be CEOs of Health Institutions and medical doctors perform and exercise their knowledge and skills in the area they can best apply them as experts in their chosen profession. 

 

(ii) Evidence showed that our hospitals fared very well under the management of health Administrators. The committee also observed in page 67 of their report that during its tour of South Africa, they discovered that CEO of health institutions are not necessarily medical doctors; yet the committee refused to recommend same to Nigeria in their report. Is the committee afraid of Nigerian Medical Doctors? Or what has gone wrong? 

 

(N) Appointment of Minister of Health (3.2.5) 

(i) In as much as the appointment of the minister of health is a constitutional matter. and is at the discretion of Mr. President, Health Minister should not necessarily be a medical doctor in the interest of harmony and stability in the health sector. It is noteworthy that whenever the Health Minister and Minister of State for Health are medical doctors, there is always rancor and instability in the sector due to injustices being perpetrated to other health professionals. However, we observed that whenever a non-medical doctor is at the helm of affairs, there is always relative peace in the sector, examples are when Prof. A. B. C. Nwosu and Prof Eyitayo Lambo were Honourable Ministers of Health. 

 

(o) Withdrawal of Doctor of Optometry and Pharm D 

(i) The minimum standard or skill required to practice a profession is determined by the regulatory body for the profession concerned. 

(ii) The name of a degree is the prerogative of the university awarding the degree. Universities award degrees of MBBS and M.D. for the same training and profession. How come a university programme under which it has been awarding a particular degree for about 30years is now being suddenly declared illegal for optometry? 

The NUC position is suspect and one can only conclude that this is doing the bidding of the NMA and its collaborators. 

More appalling was the committee's interpretation of OD(meaning Doctor of Optometry) which the committee surprisingly and erroneously defined in their report, as 'Ordinary Diploma'. 

(iii) Mr. President should note that (A) to (0) above arc just a few of issues picked from the report to buttress paragraph 2 above. When it suits thedoctors, the committee will give very clear and relevant recommendations that can relate with its findings and observations. However. When it does not suit doctors' interest, even if it is in the best interest of health care delivery services, the committee becomes evasive in its recommendations. A typical example is the fact that in South Africa, Chief Executive Officers who are not medical doctors are in charge of hospitals. The Yayale Ahmed's Committee report was evasive in making this recommendation for adoption in Nigeria. Most importantly, Hon Justice Bello A. Gusau report had earlier recommended that non-medical doctors should be Chief Executives in our health institutions. Lack of implementation of the recommendation off-Ion. Justice Bello Gusau's committee on Headship of Health Institutions is one of the factors causing disharmony in the Health sector till date. 

 

Conclusion:

We hereby appeal that our observations and recommendations in this write-up should be accommodated in the white paper in: the interest of justice, fair pIal' equity, professional autonomy and respest for rule of law. This will definitely prevent Nigeria from being a jungle as rightly expressed by President Gooluck Ebele Jonthan (GCFR) 

 

Signed

Alh. Toyosi Y. Raheem

Nation President

 

Suraj A. HJunaid 

National Secretary 

 

Adeyeye Adetunji Tam 

National PRO